Provider Demographics
NPI:1801003595
Name:REMBISZ, NICOLE S (APRN)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:S
Last Name:REMBISZ
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:S
Other - Last Name:ROY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:789 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:NH
Mailing Address - Zip Code:03820-2526
Mailing Address - Country:US
Mailing Address - Phone:603-742-3174
Mailing Address - Fax:603-742-1855
Practice Address - Street 1:10 MEMBERS WAY
Practice Address - Street 2:SUITE 203
Practice Address - City:DOVER
Practice Address - State:NH
Practice Address - Zip Code:03820-5933
Practice Address - Country:US
Practice Address - Phone:603-742-3174
Practice Address - Fax:603-742-1855
Is Sole Proprietor?:No
Enumeration Date:2007-05-16
Last Update Date:2014-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH057698-23363LP2300X
MECNP101062363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME1801003595Medicaid
NH3075387Medicaid
NHP00663897OtherMEDICARE RR
NHP00663897OtherMEDICARE RR